ketamine adjuvant for single shot thoracic paravertebral block on mrm

7/24/2019 KETAMINE ADJUVANT FOR SINGLE SHOT THORACIC PARAVERTEBRAL BLOCK ON MRM

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KETAMINE ADJUVANT FOR SINGLE SHOTTHORACIC PARAVERTEBRAL BLOCK ON

MODIFIED RADICAL MASTECTOMY

Indrati Tyas Sii TR! D"s" S#tiy"n"! Ta#$i% E%" N#&r"'"

Indrati Tyas Sii TR! D"s" S#tiy"n"! Ta#$i% E%" N#&r"'"


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BACKGROUND

Single shot thoracic paravertebral block (STPVB) is

most commonly used to provide anesthesia and

analgesia.

STPVB is more comfortable and easier to appliedthan the multiple shot TPVB.

Ketamine has localanestheticlike effects and has

been e!tensively used through epidural and caudal

routest

The effect of ketamine as ad"uvant in STPVB #ill be

e!amined in this case.


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OBJECTIVE

To evaluate the effectiveness of ketamine ad"uvant in

STPVB for managing post operative pain after $%$.


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METHODS

Si! #omans age &' years old #ere scheduled for elective

$%$.

Premedication using mida*olam .+ mg,kg.

They #ere randomi*ed into - groups (/) using in"ection

Bupivacaine .' 0 1 ./ mg epinephrine2 #ith total volume -/ cc

(-) bupivacain .'0 1 ./ mg epinephrine 1 ketamine .'mg,kg

#ith total volume -/cc.

3nduction using propofol - mg,kg2 rocuroneum .+ mg,kg.

$aintenance #ith 4- and sevoflurane.

5e evaluate post operative pain using V6S scale and

hemodynamic status of patients.

Ketorolac & mg intravenous administration started #hen Visual

6nalogue Scale 7 8.


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RESULTS

Patient #ith STPVB (/) have been managed post

operative analgetic for /92 -2 and -- hours.

3n patient #ith ketamine ad"uvant (-) the analgetic effect

have been prolonged for &2 &+2 and 8 hours.

Post operative hemodynamic status #as stable.


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VAS 1 VAS 2 VAS 3 VAS 40

5

10

15

20

25

30

35

40

Diagram score VAS and duration

Group 1

Column1

score VAS

Hours

VAS

Group 1 Group 2

1 2 3 mean 1 2 3 mean

1 9 9 9 9 12 12 12 12

2 12 12 12 12 1 18 18 17

3 15 18 18 17 24 30 30 28

4 18 20 22 20 36 37 40 38


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CONCLUSION

Ketamine as ad"uvant on STPVB #as improve acute

post operative pain management by increase the duration

of paravertebral block.


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DISCUSSION

Ketamine act on the central nervous system and #ork as

a noncompetitive antagonist of the :methyl; aspartate

receptor (:$;6%)

The :$;6% is an e!citatory glutamatergic receptor inthe spinal and supraspinal sites involved in the afferent

transmission of nociceptive signals

Ketamine #ill spread in paravertebral space and enter to

prevertebral plane2 epidural2 intercostal space and absorb

in systemic circulation on STPVB


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Thank You !

ketamine adjuvant for single shot thoracic paravertebral block on mrm

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